Peripheral circulatory failure.

Shock is a syndrome arising from any of several initiating causes, resulting in inadequate tissue perfusion. Untreated shock due to any cause can lead to irreversible cellular damage. Early diagnosis and intervention are, therefore, key to improved outcomes. In children, hypotension is not a sensitive marker for diagnosing peripheral circulatory failure. A detailed evaluation to assess perfusion particularly estimating capillary refill time and end organ perfusion is required. Septic shock is a complex condition with varying contribution of hypovolemia, cardiac dysfunction and distributive shock. Aggressive fluid therapy in the early stages is essential to recovery. Understanding the pathophysiology will help in judicious use of vasoactive drugs. Newer modalities of treatment for severe sepsis and septic shock still need evaluation in children.